Endoscopic Sedation Type During FLIP Panometry Does Not Significantly Impact FLIP Motility Classification Relative to Manometry

Abstract

Background & aims: Functional lumen imaging probe (FLIP) panometry evaluates esophageal motility at the time of sedated endoscopy and often parallels high-resolution manometry (HRM) performed in awake patients. This study aimed to assess the impact of endoscopic sedation on FLIP evaluation of esophageal motility.

Methods: Adult patients who completed FLIP panometry during sedated endoscopy and had a conclusive Chicago Classification version 4.0 diagnosis on HRM were included in this retrospective study. HRM diagnoses relative to FLIP panometry motility classifications were compared by sedation type used during FLIP (ie, conscious sedation [CS] with midazolam and fentanyl or monitored anesthesia care [MAC] with propofol).

Results: A total of 454 patients (mean [standard deviation] age 53 [17] years; 62% female) completed FLIP panometry under CS (n = 174; 38%) or MAC (n = 280; 62%; 177/280 MAC included fentanyl). On comparison of CS versus MAC, HRM diagnoses within FLIP panometry motility classifications did not differ (P = .306 across all 5 FLIP panometry classifications; P values .202-.856 within specific FLIP classifications). The proportion of HRM diagnoses within each FLIP panometry classification also did not differ between FLIP completed with CS versus MAC with fentanyl (P = .098) or MAC without fentanyl (P = .0261).

Conclusions: Whether CS or MAC was used as sedation during FLIP did not have a clinically significant impact on the relationship between diagnosis on FLIP panometry and HRM. This supports the validity of diagnosing esophageal motility disorders using FLIP panometry during sedated endoscopy.

Keywords: Achalasia; Esophageal Motility; Functional Lumen Imaging Probe (FLIP) Panometry; Manometry.